Pregnant women are quite naturally worried about the threat that COVID-19* might pose to themselves or to their unborn baby. Because COVID-19 is such a new disease, our knowledge of it is far from complete. With that caveat in mind, here is a round-up of current expert consensus on its pregnancy-specific significance.
· Pregnant women are no more vulnerable to COVID-19 than age-matched non-pregnant adults. Based on London data, 90% of infected pregnant patients have no symptoms at all. Of those with symptoms, 86 % have mild disease, 9 % have severe disease and 5% are critically unwell. A similar divide is seen in the rest of the population.
· Implications of maternal COVID-19 infection for the unborn baby are unclear. An association has been noted between maternal SARS-CoV-2* infection (with or without symptoms) and pre-term delivery/low birthweight babies. A cause and effect association has yet to be established, but experts are keeping a close eye. Avoiding catching SARS-CoV-2 whilst you are pregnant remains decidedly the safest option. This means that, irrespective of any official relaxation of lockdown restrictions in your locality, you should continue to practise physical distancing, wash your hands very frequently and avoid touching your eyes, nose and mouth.
· We still don’t know if SARS-CoV-2 can pass from Mum to baby via the placenta (‘vertical transmission’) and, if so, how such transmission might affect the baby. Presence of the virus has been demonstrated in the placenta and amniotic fluid of infected mothers, but this has not thus far resulted in a baby who has tested positive for covid disease.
COVID-19 has also impacted significantly on the provision of care to pregnant women. Public maternity units have pivoted to using Telehealth consults for most of scheduled care and antenatal classes are delivered virtually. When a face-to-face attendance is required, only the pregnant woman herself is allowed to attend, and the intention is that each such attendance should last no more than 15 minutes. The ‘standard’ 2-hour glucose tolerance test for diabetes has, for most women, been replaced by a single fasting blood glucose estimation between 24 and 28 weeks. Flu and whooping cough vaccination are still strongly advised for all pregnant women, but the preferred setting for their delivery is primary care. All of these changes intend to reduce the risk of exposing a pregnant woman to COVID-19. For the same reason, public maternity units are now strongly encouraging pregnant women to attend credentialled ‘shared-care’ GPs for the vast majority of their necessary physical check-ups. The advice to see a shared-care GP holds even for those women whose initial (pre-COVID-19) preference had been for hospital-based team midwife care. COVID-19 has changed the risk-benefit analysis, and community-based care by shared-care GPs is now, without doubt, the safest option. Shared care GPs work in partnership with the public maternity units, and measures have been put in place to ensure that it’s never been easier for us to access expert advice and support from our hospital colleagues.
And, at a practical level, what happens if you do contract COVID-19? In most cases, your illness will be mild and not requiring hospital care, but what if you are covid-positive when it comes time to deliver your baby? This is a much-feared scenario for mums-to-be, who worry whether they will still be looked after, how the baby will be delivered, will they be separated from their baby after birth, what about breastfeeding…?
The reassuring answer is that care will always be provided, but that measures will be put in place to minimise the risk of infecting other people, including your very precious newborn baby. This means that staff will wear masks, gowns, gloves and goggles when they attend you, and that you will be kept in isolation, away from other patients. You (and your birth partner) will also be asked to wear a mask. To date, there is no evidence to suggest that vaginal birth increases the risk of the baby becoming infected, and so a caesarean section would only be advised if a separate valid medical reason existed. Nitrous oxide gas for pain relief is probably not going to be an option because of the risk of viral particles aerosolising, but other options for pain relief will be offered. And as long as you are well enough to do so, you will be allowed to hold and breastfeed your baby, and to have him or her ‘room in’ with you until you are ready for discharge. You will however be advised to adopt enhanced hygiene precautions to minimise the risk of infecting your newborn. This will mean wearing a surgical mask at all times when handling your bub, and very frequent hand washing with soap and water or an alcohol-based hand rub.
*SARS-CoV-2 is the proper name for the coronavirus that is responsible for the current pandemic. The illness that it causes is called COVID-19
Want to know more?
You can click here to read RANZCOG’s information for pregnant women.
Or schedule a telehealth appointment with me if there is a specific issue you want to discuss.
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